Inflammation Control in LASIK and PRK: New Findings

Strong steroids—including prednisolone acetate, dexamethasone, and difluprednate—are known to provide excellent antiinflammatory efficacy, but their use following refractive surgery has been limited by concerns about side effects associated with long-term use of these drugs. More recently, however, surgeons have begun to focus more on the risks of poorly controlled postoperative inflammation and use of strong steroids is becoming more common, at least in the immediate postoperative period. Surgeons therefore need to consider the merits of various drugs for this application, including the new drug difluprednate.While surface ablation procedures such as LASIK and photorefractive keratectomy (PRK) do not trigger as much inflammation as intraocular procedures, poorly controlled postoperative inflammation can still result in both short-term and long-term consequences following LASIK and PRK, including haze, diffuse lamellar keratitis, and pain. Surgeons have thus devoted considerable attention to developing effective postoperative antiinflammatory regimens, with most surgeons using a steroid following LASIK and both a steroid and a non-steroidal antiinflammatory drug (NSAID) following PRK.

Off-label Use Statement: This work discusses off-label uses of antiinfective and antiinflammatory medications.

Learning Objectives:

• List 3 clinically relevant differences between topical prednisolone acetate 1% and topical difluprednate 0.05%.
• State the arguments for and against using a strong steroid to control postoperative inflammation following refractive surgery.
• List 3 non-pharmaceutical strategies to minimize inflammation following PRK.

Faculty: Eric D. Donnenfeld, MD; Karl G. Stonecipher, MD

Faculty Advisor: Sonia H. Yoo, MD